Self Care Exam 2

What is the common denominator:

- CHD

- T2DM

- Sleep apnea

-elevated triglycerides/dyslipidemia

- HTN

- Stroke/TIA

-Gallbladder Disease

- OA

-certain cancers

Obesity is a risk factor for all of these

Under current guidelines weight loss is recommended with a BMI of at least...

30

normal BMI

18.5-24.9

overweight

25-29.9

BMI of 30+

obesity

severely obese

BMI of 40+

BMI calculation

Weight(lbs)/height squared (in) x703

Muscular

can overestimate BMI when its not really a concern

waist circumference

-men with WC > 40 in

-non pregnant women with a WC>35 in

-belly fat: greater risk for developing T2DM, HL high triglycerides, HTN, CAD

Metabolic Syndrome (3 or more)

-waist circumference greater than 40 in in men or 35 in in women

-serum triglyceride levels of 150 mg/dL or greater

-HDL cholesterol level less then 40 mg/dL in men or less then 50 mg/dL in women

-blood pressure of 130 mm Hg systolic or 85 mm Hg diastolic or higher

-fasting serum glucose level of 100 mg/dL or greater

Cancers Associated with Obesity

-meningioma

-adenocarcinoma of the esophagus

-multiple myeloma

-kidney

-uterus

-ovaries

-colon and rectum

-pancreas

-upper stomach

-gallbladder

-liver

-breast

-thyroid

Obesity and Diabetes

obesity is a significant risk factor for development of type II diabetes

Obesity and CV

contributes to CV risk factors including:

-dyslipidemia

-type 2 diabetes

-hypertension

-sleep disorders

Obesity and COVID19

-increases risk of severe illness

-triple risk of hospitalization

-linked to impaired immune function

-decreased lung capacity and can make ventilation more difficult

-hospitalization, vent, ICU, death higher with increasing BMI

Leptin

A hormone produced by adipose (fat) cells that signals hypothalamus regarding energy reserves

Ghrelin

hormone produced by stomach shown to increase food intake, stimulates hunger

Sleep

-deprivation decreases leptin and increases ghrelin

-results in increased appetite

-engage in snacking if more sedentary

Medication Risk Factors

-atypical antipsychotics

-antidepressants

-OCPs

-corticosteroids

-anticonvulsants

-sulfonylureas

-TZDs

-insulin

2013 AHA/ACC/TOS obesity guideline

-identify patients who need to loos weight

-matching treatment benefit with risk

-diets for weight loss

-lifestyle interventions and counseling

-selecting patients for bariatric surgical treatment for obesity

Risk Factors and Weight

RECOMMEND LOOSE WIEGHT:

-hypertension

-high LDL cholesterol

-low HDL cholesterol

-high triglycerides

-high blood glucose

-family history of premature heart disease

-physical inactivity

-smoking

Lifestyle Modifications

-reduce calorie diet

-increase activity

-behavior therapy

-sleep hygiene

Weight Maintenance

-initial reduction of body weight by 5-10% from baseline: decreased inflammation, BP, and blood glucose

-weight regain of less than 3kg in 2 years and a sustained reduction in waist circumference of at least 4cm

-food quality

-exercise consistence

-behavioral therapy

Soda

empty calories- no nutritional value

Water

-free

-drink a glass 10 min before eating, will eat less

-amount of water, aim for 8 glasses

Metamucil

-bulk forming laxative

-helps you feel full

-good for heart and blood glucose

-fiber: good for cholesterol

-start slow to avoid gas

-mix with water: choking hazard

Calorie

-a measure of how much energy a food provides

1 gram of fat

9 calories

1 gram of CHO

4 calories

1 gram of protein

4 calories

1 gram of alcohol

7 calories

Carbohydrates

50-60% of total calories

Protein

15-20% of total calories

Fat

20-30% of total calories or less

4 key recommendations

1. prevent or reduce overwt/obesity thru improved eating and physical activity

2. control total calorie intake to manage body wt

3. increase physical activity and reduce times in sedentary behaviors

4. maintain appropriate calorie balance during each stage of life

physical activity

-add more steps in day

-start somewhere

-goal 30min moderated activity 5 days a week (may be in smaller increments, may be 75 min of vigorous activity weekly)

behavioral strategies

-environmental

-SMART goals

-self efficacy

-social support

-sleep

Orlistat MOA

-decreases absorption of dietary fats

-inhibits gastric and pancreatic lipase, specifically reduces absorption of fat by inhibiting hydrolysis of triglycerides

Orlistat Dose

60 mg per capsule: take 1-3 a day by mouth only with meals containing fat

Orlistat Efficacy

will loose 6-12 lbs in first couple months, good place to start

Orlistat Side Effects

oily stool, flatulence, anal leakage

Orlistat Counseling Points

-take w/ multivitamin due to blockage of fat soluble vitamins (A, D, E, K)

-take w/ fat containing meal

-start w/ once a day and see response